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Nail Infection: Should I Take Antifungal Pills?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Get the facts

Your options

Key points to remember

Antifungal pills give you the best chance of curing a severe
fungal nail infection.

If you have liver or heart problems, you should not take
antifungal pills. They can cause rare but dangerous
side effects, including heart and liver failure.

You may need testing every 4 to 6 weeks to check for liver,
kidney, or heart damage, depending on the antifungal pills you use.

Even if your treatment works, the infection may return. Of
people whose infections go away with antifungal pills, 15% to 20% start to get
another infection in the next year.footnote 1 This means that
out of 100 people who take the pills, 15 to 20 will get another infection in
the next year, and 80 to 85 will not.

Having your nail removed,
either
nonsurgically or
surgically, is another treatment choice for a nail
that is badly infected or thickened.

A
fungal nail infection occurs when a fungus attacks a
fingernail, a toenail, or the skin under the nail, called the nail bed.
Fungi (plural of fungus) can attack your nails through
small cuts in the skin around your nail or through the opening between your
nail and nail bed.

Fungal nail infections are more common in
toenails than fingernails. Toenails grow very slowly, giving the fungi
more time to develop and get worse. It also takes more time to treat toenails
than fingernails.

Yeasts, molds, and different kinds of fungi can
cause fungal nail infections. Most are caused by the same type of fungus that
causes
athlete's foot. Fungi grow best in warm, moist places,
and they can spread from person to person. You can get a fungal nail infection
from walking barefoot in public showers or pools or from sharing personal
items, such as towels and nail clippers. If you have athlete's foot, the fungus
can spread from your skin to your nails.

You might use antifungal pills if topical treatments have not worked. A fungal nail infection doesn't go away on its own. And it slowly gets worse over time. An infection may spread into the nail root,
where new nail growth begins, and may spread to other nails. The longer you
have an infection and the worse it gets, the harder it is to treat.

Severe infections, especially in older people who have had the condition
for many years, can cause very thick nails that are hard to trim. They may
cause pain or discomfort when you walk. If this happens, it is hard to cure a
fungal infection, even with antifungal pills.

Not all fungal nail infections need treatment with pills. Some
people decide not to treat a fungal infection until it is uncomfortable or
painful.

Nail infections are hard to treat, and antifungal pills
can be costly. There is no guarantee that the pills will work or that the
infection won't come back. Of people whose infection goes away with antifungal
pills, 15% to 20% start to get another infection in the next year.footnote 1 This means that out of 100 people who use antifungal pills,
15 to 20 will get another infection in the next year, and 80 to 85 will not.

The pills used to treat fungal nail infections can cause serious
side effects, including liver damage and
heart failure.

You might think about
trying other treatments, such as using an antifungal cream or removing the
nail, either
surgically or
nonsurgically.

Curing the infection with pills doesn't work as well in people who are 65 and older.footnote 2

Pills to treat fungal nail
infections include terbinafine (Lamisil) and itraconazole (Sporanox). Studies comparing these two medicines found that terbinafine cured the infection in 55 out of 100 people and itraconazole cured the infection in 26 out of 100 people after 16 weeks of treatment.footnote 2

Fluconazole (Diflucan) and griseofulvin (Grifulvin V) are
used less often. Fluconazole seems to help, but not as much as itraconazole or terbinafine.footnote 2 There isn't enough evidence to show how well griseofulvin works.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My toenails
have always been a little thick and hard to trim, but lately they are starting
to really make my feet hurt. I was never sure what the problem was, and now my
doctor says it's some type of fungal infection. She says that the medicine
may help but that my nail is probably damaged and will never grow back in
completely normal. She also mentioned that the medicine is pretty expensive,
and that's a concern for me. I'm going to try some other treatment that takes
off part of the nail and see if that helps with the pain.

Tom, age 68

I think
this fungal toenail infection is the ugliest thing! It's so embarrassing. I
always keep my nails trimmed and polished, and this one ugly toenail really
bothers me. I asked my doctor about these new medicines, and it sounds like
they will work well for me, because the problem is just in one of my nails. I
just can't believe how long it's going to take to work!

Tammy, age 35

Taking
medicines for almost 3 months to treat something that really doesn't bother
me? That doesn't make any sense to me. I have a hard enough time remembering
everything I need to do at the office, much less remembering to take a pill
every day. If the problem gets any worse, then I'll reconsider. For now, I'll
just keep that toenail out of sight.

Bonita, age 40

I will
always remember my dad's feet. He had these thick, ugly yellow toenails, and he
used to wince when he would walk, because they hurt his feet. My doctor says
that I could wind up in the same situation. But since I just got this fungal
toenail infection in the last year, if we treat it now, we have a good chance
of curing it. I'm going to try this oral medicine that takes several months
to work. I'm also going to try all the other things he mentioned, like rotating
my shoes so they dry, changing my socks more, and using antifungal foot drying
powder. I don't care so much what my feet look like, but I sure don't want them
to hurt when I'm older.

Bob, age 60

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antifungal pills

Reasons not to take antifungal pills

I'm worried about my infection getting worse.

I'm not worried about my infection getting worse.

More important

Equally important

More important

I'm willing to have regular blood tests to check that my liver and kidneys are okay.

I don't want to be bothered with a lot of tests.

More important

Equally important

More important

I accept the risk of pills.

Taking these pills is too risky for me.

More important

Equally important

More important

I don't mind taking pills every day for several months.

I don't want to take pills every day.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antifungal pills

NOT taking antifungal pills

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, Do antifungal pills give you the best chance of curing severe fungal nail infections?

YesYou're right. Antifungal pills give you the best chance of curing a severe fungal nail infection.

NoSorry, that's not right. Antifungal pills do give you the best chance of curing a severe fungal nail infection.

I'm not sureIt may help to go back and read "Key points to remember." Antifungal pills give you the best chance of curing a severe nail infection.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Nail Infection: Should I Take Antifungal Pills?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

1. Get the Facts

Your options

Key points to remember

Antifungal pills give you the best chance of curing a severe
fungal nail infection.

If you have liver or heart problems, you should not take
antifungal pills. They can cause rare but dangerous
side effects, including heart and liver failure.

You may need testing every 4 to 6 weeks to check for liver,
kidney, or heart damage, depending on the antifungal pills you use.

Even if your treatment works, the infection may return. Of
people whose infections go away with antifungal pills, 15% to 20% start to get
another infection in the next year.1 This means that
out of 100 people who take the pills, 15 to 20 will get another infection in
the next year, and 80 to 85 will not.

Having your nail removed,
either
nonsurgically or
surgically, is another treatment choice for a nail
that is badly infected or thickened.

FAQs

What is a fungal nail infection?

A
fungal nail infection occurs when a fungus attacks a
fingernail, a toenail, or the skin under the nail, called the nail bed.
Fungi (plural of fungus) can attack your nails through
small cuts in the skin around your nail or through the opening between your
nail and nail bed.

Fungal nail infections are more common in
toenails than fingernails. Toenails grow very slowly, giving the fungi
more time to develop and get worse. It also takes more time to treat toenails
than fingernails.

Yeasts, molds, and different kinds of fungi can
cause fungal nail infections. Most are caused by the same type of fungus that
causes
athlete's foot. Fungi grow best in warm, moist places,
and they can spread from person to person. You can get a fungal nail infection
from walking barefoot in public showers or pools or from sharing personal
items, such as towels and nail clippers. If you have athlete's foot, the fungus
can spread from your skin to your nails.

Why would you use antifungal pills to treat a nail infection?

You might use antifungal pills if topical treatments have not worked. A fungal nail infection doesn't go away on its own. And it slowly gets worse over time. An infection may spread into the nail root,
where new nail growth begins, and may spread to other nails. The longer you
have an infection and the worse it gets, the harder it is to treat.

Severe infections, especially in older people who have had the condition
for many years, can cause very thick nails that are hard to trim. They may
cause pain or discomfort when you walk. If this happens, it is hard to cure a
fungal infection, even with antifungal pills.

Why wouldn't you use antifungal pills to treat a nail infection?

Not all fungal nail infections need treatment with pills. Some
people decide not to treat a fungal infection until it is uncomfortable or
painful.

Nail infections are hard to treat, and antifungal pills
can be costly. There is no guarantee that the pills will work or that the
infection won't come back. Of people whose infection goes away with antifungal
pills, 15% to 20% start to get another infection in the next year.1 This means that out of 100 people who use antifungal pills,
15 to 20 will get another infection in the next year, and 80 to 85 will not.

The pills used to treat fungal nail infections can cause serious
side effects, including liver damage and
heart failure.

You might think about
trying other treatments, such as using an antifungal cream or removing the
nail, either
surgically or
nonsurgically.

How well do antifungal pills work?

Curing the infection with pills doesn't work as well in people who are 65 and older.2

Pills to treat fungal nail
infections include terbinafine (Lamisil) and itraconazole (Sporanox). Studies comparing these two medicines found that terbinafine cured the infection in 55 out of 100 people and itraconazole cured the infection in 26 out of 100 people after 16 weeks of treatment.2

Fluconazole (Diflucan) and griseofulvin (Grifulvin V) are
used less often. Fluconazole seems to help, but not as much as itraconazole or terbinafine.2 There isn't enough evidence to show how well griseofulvin works.

What are the risks of not using pills to treat a nail infection?

If you are healthy, an ongoing fungal nail infection
has no serious risks. But over time, the nail may get thick and look bad. It
may be painful when you wear shoes or walk.

If you have
diabetes or a weak
immune system, a fungal infection can lead to a more
serious bacterial infection.

Personal stories

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My toenails have always been a little thick and hard to trim, but lately they are starting to really make my feet hurt. I was never sure what the problem was, and now my doctor says it's some type of fungal infection. She says that the medicine may help but that my nail is probably damaged and will never grow back in completely normal. She also mentioned that the medicine is pretty expensive, and that's a concern for me. I'm going to try some other treatment that takes off part of the nail and see if that helps with the pain."

— Tom, age 68

"I think this fungal toenail infection is the ugliest thing! It's so embarrassing. I always keep my nails trimmed and polished, and this one ugly toenail really bothers me. I asked my doctor about these new medicines, and it sounds like they will work well for me, because the problem is just in one of my nails. I just can't believe how long it's going to take to work!"

— Tammy, age 35

"Taking medicines for almost 3 months to treat something that really doesn't bother me? That doesn't make any sense to me. I have a hard enough time remembering everything I need to do at the office, much less remembering to take a pill every day. If the problem gets any worse, then I'll reconsider. For now, I'll just keep that toenail out of sight."

— Bonita, age 40

"I will always remember my dad's feet. He had these thick, ugly yellow toenails, and he used to wince when he would walk, because they hurt his feet. My doctor says that I could wind up in the same situation. But since I just got this fungal toenail infection in the last year, if we treat it now, we have a good chance of curing it. I'm going to try this oral medicine that takes several months to work. I'm also going to try all the other things he mentioned, like rotating my shoes so they dry, changing my socks more, and using antifungal foot drying powder. I don't care so much what my feet look like, but I sure don't want them to hurt when I'm older."

— Bob, age 60

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antifungal pills

Reasons not to take antifungal pills

I'm worried about my infection getting worse.

I'm not worried about my infection getting worse.

More important

Equally important

More important

I'm willing to have regular blood tests to check that my liver and kidneys are okay.

I don't want to be bothered with a lot of tests.

More important

Equally important

More important

I accept the risk of pills.

Taking these pills is too risky for me.

More important

Equally important

More important

I don't mind taking pills every day for several months.

I don't want to take pills every day.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antifungal pills

NOT taking antifungal pills

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do antifungal pills give you the best chance of curing severe fungal nail infections?

Yes

No

I'm not sure

You're right. Antifungal pills give you the best chance of curing a severe fungal nail infection.

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